Table 7.

Anticoagulant bridging.

There are no randomised trials evaluating peri-operative outcomes in surgical patients taking novel oral anticoagulants In the presence of normal renal function, it is advised that dabigatran can be stopped 24-hours prior to surgery139 With renal impairment or high risk of bleeding, dabigatran should be discontinued 2–4 days prior to surgery In high-risk patients, a laboratory measure of anticoagulation ought to be sought Anticoagulant bridging raises the issue of patients entering a prothrombotic state following cessation of a novel agent: in ROCKET-AF, there was a significantly increased risk of stroke in the rivaroxaban arm in the 28-day period after rivaroxaban was stopped and patients were transitioned to another anticoagulant The decision regarding how to bridge anticoagulant therapy requires the judgment of an experienced clinician who must considerthe type of surgery, the relative risk of bleeding and thromboembolism, the renal function and the quality of anticoagulation